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surgery > pancreas and spleen > Flashcards

pancreas and spleen Flashcards

1
Q

where does the spleen lie

A

in the leaf of greater omentum

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2
Q

what attaches the spleen to the stomach

A

gastrosplenic ligament

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3
Q

nodular lymphoreticular tissue

A

white pulp

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4
Q

what part of the parenchyma is the site of immune response in the spleen

A

white pulp

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5
Q

this section of the spleen stores RBC and traps antigens

A

red pulp = venous sinuses

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6
Q

calcium/iron deposits on the spleen - normal finding

A

siderotic plaques

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7
Q

accessory spleen

A

incidental ectopic tissue

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8
Q

usually from seeding of cells after trauma or sx

A

splenosis

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9
Q

spleen stores ___% RBC and ___% platlets

A

10-20% RBC

30% plts

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10
Q

T/F

we need the spleen to live

A

no

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11
Q

symmetric spleen enlargement

A

splenomegaly -
drug induced
congestion/torsion
immune mediate dz

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12
Q

asymmetric spleen enlargement

A

masses - neoplasia
hematoma
nodular hyperplasia

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13
Q

splenic torsion is most common with what

A

GDV
– or stretching of gastrosplenic ligament in previous GDV incident

large giant breed dogs

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14
Q

signs of acute splenic torsion

A 
acute abdomen normally due to gdv 
pain and shock 
distension
cvs collapse 
dysrhythmias 
DIC
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15
Q

signs of chronic splenic torsion

A 
intermittent for 2 weeks 
vomit and diarrhea 
anemia 
hematuria 
pu/pd
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16
Q

splenic torsion diagnostic test of choice

A

ultrasound

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17
Q

what will be seen on ultrasound to confirm splenic torsion

A

diffuse hypoechoic areas
intraluminal echogenic densities in veins
no flow in splenic vessels

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18
Q

what do rads show for splenic torsion

A

c shaped spleen
mid abdominal mass
effusion
gas bubbles in spleen

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19
Q

definitive tx for splenic torsion

A

exploratory laparotomy followed by splenectomy

**gastropexy too bc once spleen removed more likely to get gdv

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20
Q

T/F

derotate the spleen before splenectomy

A

FALSE NEVER DEROTATE THE SPLEEN BEFORE A SPLENECTOMY

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21
Q

T/F

ideally submit the spleen for histopath to ensure no underlying pathology to the torsion

A

true

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22
Q

survival to discharge of splenic torsion

A

91%

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23
Q

splenic torsion breed predisposition

A

GSD
danes
english bulldogs

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24
Q

what is not a cause ever of splenic torsion

A

neoplasia

need to differentiate tumor from torsion bc both show mass effect on rads

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25
Q

T/F

splenic infarction is an emergency and surgery needs done immediately

A

false - do not race to surgery, usually infarction is due to a systemic problem, sort that out first

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26
Q

example of a splenic hyperactivity disorder

A

IMHA - diffuse hyperplasia

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27
Q

diagnostic dilemma with nodular hyperplasia

A

FNA cytology can look like cancer because there is poor sensitivity

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28
Q

sites of extrameduallary hyperplasia

A

nodular hyperplasia

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29
Q

T/F

most splenic nodular hyperplasia was an incidental finding and benign

A

true

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30
Q

rupture of capsule and parenchyma of spleen

A

blunt force - splenic trauma

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31
Q

how to treat splenic trauma

A

conservative mgmt
compression bandage

total splenectomy

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32
Q

1 splenic neoplaia in dog

A

HSA

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33
Q

1 splenic neoplasia in cat

A

mast cell tumor

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34
Q

what is the rule of 2/3

A

2/3 of dogs with a splenic mass will be malignant

and 2/3 of those malignancies will be HSA

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35
Q

risk factors for HSA

A

older
>21 kg
GSD, lab, golden, poodle
presence of hemoperitoneum

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36
Q

presence of hemoperitoneum increases chance of splenic malignancy by what %

A

> 80%

NOT A RISK FACTOR IN SMALL DOGS THOUGH!!!!!!

37
Q

why is the px so poor for HSA

A

nearly all cases have microscoping mets at the time of diagnosis

1-3 months

38
Q

prognosis of HSA surgery alone

A

1-3 months

39
Q

prognosis HSA

surgery + chemo/palladia

A

5-6 months

1 year in 10% of cases

40
Q

HSA prognosis in surgery + chemo + immunotherapy

A

stage 1 (non ruptured spleen) - 425 days

stage 2 (ruptured spleen) - no benefit

41
Q

alternative adjunctive therapy in hsa

A

turkey tail mushroom - c versicolor

contains psp which causes cell cycle arrest at the g1/s checkpoint = more apoptosis of cancer cells

42
Q

complete splenectomy 2 techniques

A
  1. ligation of individual hilar vessels

2. ligation of splenic and short gastric arteries

43
Q

which splenectomy technique preserves branches to the pancreas and stomach

A

hilar dissection

44
Q

limit of hemostatic clips

A

<4 mm vessels

45
Q

what does LDS stand for

A

ligate divide stapler

46
Q

electrothermal bipolar system can handle vessels of what size

A

up to 7mm without thermal damage

much faster and no foreign material is left behind

47
Q

most common complication of splenectomy

A

hemorrhage

48
Q

iatrogenic complications of splenectomy

A

pancreatitis/necrosis

gastric wall compromise

49
Q

if this complication is present post splenectomy there is a 2x higher risk of death

A

ventricular arrhythmias

monitor with 24 hour telemetry - holtor

50
Q

what supplies blood to the left limb of the pancreas

A

branch of splenic a

51
Q

what supplies blood to the right limb and body of the pancreas

A

cd pancreaticoduodenal a –> branch of cranial mesenteric a

52
Q

enters duodenum at the major duodenal papilla with the bile duct

A

pancreatic duct

**primary/only duct in cats

53
Q

drains into the duodenum at the minor duodenal papilla in dogs

A

accessory pancreatic duct

54
Q

drains the left lobe of the kidney

A

accessory pancreatic duct

55
Q

drains the right lobe of the kidney

A

pancreatic duct

56
Q

make glucagon

A

alpha cells

57
Q

make insulin

A

beta cells – 60-75% of islet cells

58
Q

endocrine pancreas is made of what

A

islet of langerhans

59
Q

delta cells

A

somatostatin

60
Q

f cells

A

pancreatic polypeptide

61
Q

T/F

pancreatitis is a very common and surgical disease

A

false - very common but not surgical

62
Q

surgical biopsy technique of pancreas if diffuse disease is present

A

suture fracture - guillotine technique

63
Q

indications of partial pancreatectomy

A

tumor removal

64
Q

what two tools work best for ligations in partial pancreatectomy

A

hemoclips or bipolar cautery

65
Q

what percent of the pancreas can be removed if the ramaining ducts are patent

A

80%

66
Q

what is the most common and unpredictable complication of a partial pancreatectomy

A

pancreatitis - warn the owners

67
Q

what is a complication of partial pancreatectomy if > 80-90% is removed

A

endocrine pancreatic insufficiency – treat with insulin supplements

68
Q

dr cavs tool of choice for pancreatic surgery

A

ligasure – does not cause pancreatitis in its patients

69
Q

devitilization of duodenum

A

if the pancreaticoduodenal arety (which arises from the cranial mesenteric artery) is damaged in surgery of the pancreas, the duodenum could be compromised

70
Q

Collections of pancreatic secretions & cellular debris w/in fibrous sac or wall of granulation tissue

A

pancreatic pseudocyst

71
Q

pancreatic pseudocysts lack this feature and therefore they are not true cysts

A

epithelial walls

72
Q

T/F

pancreatic pseudocysts are often an incidental finding

A

true

73
Q

pancreatic pseudocysts dx test of choice

A

ultrasound

74
Q

pancreatic pseudocysts treatrment

A

only resect if ill from the disease, or debride and omentalize

75
Q

usually secondary to bouts of pancreatitis

A

pancreatic abscess

76
Q

lab results on pancreatic abscess

A

hyperbilirubinemia

elevated liver enzymes due to EHBO – inflammed pancreas is causing duodenal papilla to swell shut

77
Q

important to do post op for pancreatic abcess surgery patients

A

post gastric feeding tube

78
Q

prognosis in pancreatic abscess patients

A

poor

79
Q

exocrine pancreatic adenocarcinoma prognosis

A 
50-78% mets at dx 
sx resection if possible 
very poor 
3 months in dogs 
<7 days in cats
80
Q

insulinoma

A

beta cells continue to secrete insulin even though hypoglycemic

81
Q

T/F

insulinoma is 100% malignant

A

false – 90% but like…

82
Q

what is whipples triad

A

way to dx insulinoma
clinical signs associated with hypoglycemia
fasting blood glu of 40 or lower
relief of neuro signs when fed glucose

83
Q

what is the most diagnostic for insulinoma

A

fasting insulin-glucose ratio

insulin is HIGH despite hypoglycemia

normal should be 5 to 26
insulinoma insulin levels exceed 70

84
Q

diazoxide

A

oral hyperglycemia agent that inhibits pancreatic insulin secretion and glucose uptake by tissue

85
Q

how does glucocorticoid therapy work to help medically manage insulinoma

A

increases hepatic glucose production and decreases cellular glu uptake

86
Q

what diet to feed insulinoma patient

A

small frequent meals
high protein
complex carbs

87
Q

gold standard surgical mgmt for insulinoma

A

partial pancreatectomy

88
Q

Describes syndrome of gastric acid hypersecretion, gastrointestinal ulceration & non–β-cell pancreatic tumors

A

zollinger-ellison syndrome

89
Q

gastrinoma diagnostic

A

high serum gastrin levels

surgery (18 decks)

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